J. Meynadier

Treatment of psoriasis with a 311‐nm UVB lamp

In a left‐right comparative study, the Philips TL‐01 sunlamp, a new UVB fluorescent lamp, was evaluated in 15 patients with symmetrical psoriasis. One half of the body was treated in a cabin containing TL‐01 lamps, and the other half in a cabin containing TL‐12 lamps. The patients were treated three times/week, and the study was conducted in a randomized, double‐blind fashion. The percentage response of psoriatic lesions was determined on the tenth and twentieth exposures. The therapeutic effect of the TL‐01 lamps was superior to that of the TL‐12 lamps, and treatment was better tolerated, particularly with regard to episodes of burning. This new lamp appears to provide more effective and safer phototherapy for psoriasis.

Efficacy and safety of calcipotriol (MC 903) ointment in psoriasis vulgaris : a randomized, double-blind, right/left comparative, vehicle-controlled study

BACKGROUNDnThe biologically active form of vitamin D3, calcitriol, may offer a new therapeutic approach to psoriasis. Calcipotriol, a new vitamin D3 analogue, is at least 100 times less calcemic than calcitriol.nnnOBJECTIVEnOur purpose was to study the efficacy and safety of calcipotriol in the treatment of psoriasis vulgaris.nnnMETHODSnIn a right/left comparative, double-blind study, treatment with calcipotriol ointment (50 micrograms/gm) twice daily and placebo was given for 4 weeks. The preferred treatment was continued, without opening the code, for another 4 weeks. Efficacy, as measured by the Psoriasis Area and Severity Index and by the investigators and patients global assessment, and safety were assessed every 2 weeks.nnnRESULTSnThe mean Psoriasis Area and Severity Index fell in 4 weeks from 14.2 to 6.3 with calcipotriol and from 14.1 to 9.2 with placebo (p < 0.001; 95% confidence interval for difference: 1.78-->3.94). Local side effects were equally common with calcipotriol and placebo. The mean serum calcium remained unchanged.nnnCONCLUSIONnTopical application of up to 50 gm of calcipotriol ointment per week was found to be an effective and safe treatment of psoriasis vulgaris.

Multicenter Randomized Comparative Double-Blind Controlled Clinical Trial of the Safety and Efficacy of Zinc Gluconate versus Minocycline Hydrochloride in the Treatment of Inflammatory Acne vulgaris

Background: In addition to tetracyclines, zinc may constitute an alternative treatment in inflammatory lesions of acne. Objective: To evaluate the place of zinc gluconate in relation to antibiotics in the treatment of acne vulgaris. Methods: Zinc was compared to minocycline in a multicenter randomized double-blind trial. 332 patients received either 30 mg elemental zinc or 100 mg minocycline over 3 months. The primary endpoint was defined as the percentage of the clinical success rate on day 90 (i.e. more than 2/3 decrease in inflammatory lesions, i.e. papules and pustules). Results: This clinical success rate was 31.2% for zinc and 63.4% for minocycline. Minocycline nevertheless showed a 9% superiority in action at 1 month and one of 17% at 3 months, with respect to the mean change in lesion count. Regarding safety, the majority of the adverse effects of zinc gluconate and of minocycline concerned the gastrointestinal system and weremoderate (5 dropouts with zinc gluconate and 4 with minocycline). Conclusion: Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but minocycline has a superior effect evaluated to be 17% in our study.

Ultraviolet AI exposure of human skin results in Langerhans cell depletion and reduction of epidermal antigen-presenting cell function: partial protection by a broad-spectrum sunscreen

Backgroundu2003Ultraviolet (UV) B‐induced effects on the skin immune system have been extensively investigated, but little is known regarding the immunological changes induced by UVA exposure of human skin. Recent data assessing the protection afforded by sunscreens against photoimmunosuppression stress the need for broad‐spectrum sunscreens with an adequate UVA protection.

Immunosuppression induced by acute solar-simulated ultraviolet exposure in humans: prevention by a sunscreen with a sun protection factor of 15 and high UVA protection.

BACKGROUNDnCutaneous exposure to UVB radiation impairs the induction of contact hypersensitivity (CHS). Variable results have been found among studies examining the use of sunscreens to prevent UV-induced immunosuppression.nnnOBJECTIVEnOur purpose was to determine whether solar-simulated exposure of human skin resulted in an impairment of CHS responses and whether the preapplication of an intermediate sun protection factor (SPF) sunscreen could prevent this locally UV-induced immunosuppression.nnnMETHODSnIrritant and CHS responses to dinitrochlorobenzene (DNCB) were randomly assessed in 160 human volunteers with or without UV exposure and with or without prior application of an SPF 15 sunscreen with high UVA protection. DNCB sensitization was performed 3 days after acute UV irradiation corresponding to 3 minimal erythema doses.nnnRESULTSnAfter solar-simulated UV exposure, the percentage of positive responses to DNCB sensitization dropped from 95% to 50% (p = 0.003). Prior application of the sunscreen formulation did not modify the percentage of positive responses (90%) and maintained the immunization rate at 85% among volunteers exposed to UV.nnnCONCLUSIONnA localized sunburn can impair the afferent arm of CHS reactions in humans. The use of intermediate SPF sunscreens with high UVA protection adequately protects from the suppression of CHS responses that occurs after acute solar-simulated UV exposure.

Is combined oral and topical therapy better than oral therapy alone in patients with moderate to moderately severe acne vulgaris? A comparison of the efficacy and safety of lymecycline plus adapalene gel 0.1%, versus lymecycline plus gel vehicle.

This multicenter, randomized, investigator-blinded study compared the efficacy and tolerability of a combination of lymecycline 300 mg/day orally and adapalene topical gel 0.1% (n = 118) to lymecycline 300 mg/day orally plus vehicle gel (n = 124) in patients with moderate to moderately severe acne vulgaris with both inflammatory and noninflammatory lesions. The primary efficacy end point, total lesion count at end point (last observation carried forward), showed a statistically significant difference in favor of the lymecycline plus adapalene group (P =.0011). The mean decrease in total, inflammatory and noninflammatory lesion counts was significantly greater at end point in the lymecycline plus adapalene group than in the lymecycline plus vehicle group (P <.01). In addition, a significant difference for inflammatory and total acne lesions was seen sooner in the adapalene plus lymecycline group. In total, 75.5% of patients in the lymecycline plus adapalene group were markedly improved, almost clear or clear of their lesions at week 12, compared with 51.8% of those in the lymecycline plus vehicle group (P <.001). Local cutaneous tolerance was generally good in both groups, although more patients receiving the lymecycline plus adapalene combination experienced cutaneous reactions than those receiving lymecycline plus vehicle. There are relatively few studies comparing the efficacy of combined oral and topical therapy with either individual therapy alone. This study clearly demonstrates that lymecycline plus adapalene combination treatment resulted in a significantly greater mean decrease in the number of inflammatory, noninflammatory and total lesions than lymecycline plus vehicle and was well tolerated.

Acquired progressive lymphangioma

Acquired progressive lymphangioma (APL) is a rare, benign proliferation of lymphatic capillary origin, which is characterized histologically by dermal vascular channels and a ‘dissection of collagen’ appearance. We describe a 30‐year‐old patient with an extensive, refractory APL on the right breast, which slowly developed over a period of 23years. Pathologists and dermatologists should be aware of this entity, as early surgical treatment may be totally curative when the lesion is limited in size.

Adult cutaneous Langerhans cell histiocytosis: remission with thalidomide treatment

raised random blood glucose (8-2 mmol/1) was a 67-year-old man with no diabetic symptoms, who had a family history of diabetes mellitus. None of the three women (aged 72, 78 and 79 years) shown to have a urinary tract infection had any urinary symptoms. All patients with significant abnormalities were aged over 60 years. Dipstick urinalysis has an appreciable cost, hased on the nurses time (about 2 min) in performing the analysis, disposing of the specimen and recording the result, and the cost of the dipstick and specimen pot. In 1989, it was estimated that the cost to perform a dipstick urinalysis test was

Pachydermodactyly or acquired digital fibromatosis

3 (about £2).^ Based on this calculation, the overall cost to detect the two patients with serious conditions (transitional cell carcinoma and renal stones) would he ahout £500 per case. The cost per case would he reduced considerahly if patients under the age of 60 years were not tested. This study supports the view that dipstick urinalysis screening, especially for haematuria, can he worthwhile in asymptomatic patients. Testing should be confined to those over the age of 60 years, as it is of little value in younger subjects.

On quantification of CD1a, HLA-DR, and HLA class I expression on viable human Langerhans cells and keratinocytes.

between the nail plates of the fingers and toes may, however, be a manifestation of site and mcchfinical factors acting upon the same abnormality of ihe nail matrices, rather than a reflection of two dilTerent pathological processes. Our patient represents a new, apparently benign, congenital nail dystrophy associated with acro-osteolysis. in which the fingernails and loenails are affected differently.